mental health

When mental health robbed England of its king for over a year

Both Prince William and Prince Harry have spoken openly about their own mental health and the impact of losing their mother and growing up in the public eye. Together they have formed a charity to support young people with mental health problems. They aim to remove a stigma which still remains in the 21st century.

This musing goes back to another royal with mental health problems, this time in the 15th century. Problems whose diagnosis we still can’t identify and which led to his downfall and changed the course of history in England.

It’s 1453 and to say that King Henry VI of England has a lot on his plate would be an understatement. The Battle of Castillon on 17th July effectively ends the Hundred Years War with France and sees Henry lose the last part of an empire which once had stretched from the Channel to the Pyrenees. At home this defeat stoked the embers of rebellion. The War of the Roses is imminent. For Henry defeat was a personal blow too. He was the son of Henry V; war hero of Agincourt. He succeeded the throne in 1422 aged only nine months after his father’s sudden death and by the time he was deemed old enough to rule in his own right in 1437 the war with France had already turned against England. Henry was unable to live up to his father’s legend and reverse the slide putting his reign under increasing pressure from the very beginning.

King Henry VI

King Henry VI

Henry did have one thing going for him, his wife Margaret of Anjou whom he married in 1445. By the summer of 1453 she was pregnant. Strong willed and volatile she was far more willing than Henry to stand firm and make decisions. Henry deplored violence and would rather spare traitors and cut back himself instead of raising taxes. Royal duties were a distraction from his preferred activities; praying and reading religious texts. Admirable, but not ideal when revolution is in the air. As Henry began to earn his reputation as one of England’s weakest ever kings Margaret would come to be the de facto monarch. He would soon need her even more.

Margaret of Anjou

Margaret of Anjou

10th August 1453 at the royal lodge in Clarendon near Salisbury. Henry receives news of the defeat at Castillon and the deaths of one of his most faithful and talented commanders John Talbot, Earl of Shrewsbury and his son. Suddenly he falls unwell. Without warning he acts unaware of his surroundings, unresponsive to anyone and anything around him and seemingly unable to even move. With England on the verge of civil war his entourage are understandably keen to keep this under wraps and hope it passes. It doesn’t. Margaret stays in London and the royal court continues as normal. In early October, accepting how ill the king is, his court moves him gradually to Windsor. On 13th October Margaret goes into labour and is delivered of a baby boy, Edward. Henry is informed of the birth of his heir but doesn’t react. In the New Year Margaret brings Prince Edward to Henry. Both her and the Duke of Buckingham beg Henry to bless the young prince. Other than moving his eyes he does nothing. At the time he has to be fed and guided around the palace by his attendants.

One 22nd March 1454 John Kemp, the Archbishop of Canterbury and Lord Chancellor of England dies. The news is given to Henry by a delegation of bishops and noblemen in the hope he will wake and announce a successor. The group report back to Parliament that the king remained unresponsive. That same month a commission sends a group of doctors to treat Henry. They are provided with a list of possible treatments including enemas, head purging (heat applied to the head), laxatives and ointments. Whatever treatment they chose nothing works.

As suddenly as Henry fell ill he recovered after nearly 18 months on Christmas Day 1455. On 30th December Margaret brought Edward to Henry. The king was delighted and acted as though he was meeting the prince for the first time. Margaret was overjoyed, but with an agenda. During Henry’s illness Richard of York had claimed the title of Lord Protector and on the death of John Kemp placed his brother-in-law Richard Neville as the new Chancellor, a move Margaret opposed. Edmund Duke of Somerset, a rival of Richard’s and an ally of Margaret’s, was sent to the Tower of London. Richard was a relative of Henry’s and had a claim to throne. A claim scuppered by the birth of Prince Edward. The life of her son was in jeopardy. With Henry now well again Margaret persuaded him to remove Richard from favour and restore Somerset from the Tower. So intensified the resentment. Richard would begin to grow his support. The Wars of the Roses sprang from these personal rivalries. Had Henry not been unwell it’s possible the Wars of the Roses could have been avoided.


So what was Henry’s illness? Much has been made of a supposed family history of mental health problems. His maternal grandfather King Charles VI of France suffered recurrent bouts of violence and disorientation, not recognising his family or remember he was king. These bouts lasted months at a time. It is possible they were due to mental illness such as bipolar disorder or schizophrenia. However, they seemed to follow a fever and seizures he suffered in 1392. Potentially Charles’s ‘madness’ may have been due to an infection such as encephalitis rather than psychiatric illness.

The length of Henry’s illness and sudden improvement with no apparent ill effect make schizophrenia or catatonic schizophrenia unlikely. The length of illness again along with the loss of awareness and memory make a depressive illness unlikely. There’s no record of him being similarly ill at another time of his life. It is is possible he suffered a severe dissociative disorder due to stress. Of course, it is completely plausible that contemporary accounts are inaccurate or incomplete, never mind the fact that it is impossible to make a diagnosis of a patient you haven’t met, never mind one who died six centuries ago.

Henry would cling to the throne until he was deposed in 1461, replaced by Edward IV, son of Richard of York. Henry was imprisoned and Margaret fled to Scotland with their son. But she wasn’t finished. She would reach out to Richard Neville and form an alliance based on an arranged marriage between her son and his daughter. Neville would force out Edward IV and reinstate Henry in 1470. It was to be a short return however. Edward IV raised an army and in the ensuing conflict both Richard Neville and then Henry’s son died in combat in early 1471. Henry once again was imprisoned in the Tower of London. He died mysteriously, possibly murdered on the orders of Edward IV, in 1471. His mental health was blamed, with supporters of Edward IV claiming he died of a broken heart at the loss of his son. Margaret was also imprisoned until she was ransomed by King Louis XI of France in 1475. She lived out her days in France until she died in 1482.

King as long as he could remember, losing his kingdom and facing potential rebellion and death it’s no wonder Henry’s mental health suffered. But what I think is remarkable is that at a time of no mental health knowledge his court was able to keep him fed and watered and otherwise healthy for 18 months. Even in the time since their mother died in 1997 Princes William and Harry are showing how far we have come in appreciating mental health. Their ancestor King Henry VI is a powerful example of the impact of mental health.

Thanks for reading

- Jamie

We Need to Talk About Kevin: Is Kevin McCallister a Psychopath?

Home alone tooth 2.gif

It’s Christmas time, there’s no need to be afraid. At Christmas time we let in light and we banish shade. And usually sit down to watch a number of Christmas films including one or both of Home Alone (1990) or Home Alone 2: Lost in New York (1992)*. Both films were written and produced by John Hughes and directed by Chris Colombus and star Macaulay Culkin as Kevin McCallister as a young boy left home at Christmas in the first film and who ends up in New York in the second. In both he has to defend himself against a couple of bumbling burglars ‘The Wet Bandits’, Harry (Joe Pesci) and Marv (Daniel Stern). Home Alone remains the highest grossing live action comedy in the US and only lost the worldwide title in 2011 to The Hangover II. Both films are firm fixtures for Christmas watching.

Yet, on a recent viewing the other day there was an easy question in my mind. Not the sad decline of Macaulay Culkin from childhood star to example for any child who becomes famous or even the fact that the McCallister family would clearly have social services swarming over them. No, this question was about the character of Kevin himself. Beyond all the jokes and slapstick, is Kevin McCallister a psychopath?

I’m not a psychiatrist so I first had to look up the criteria to make a diagnosis. Turns out psychopathy doesn’t really exist anymore as a diagnosis and has been largely replaced by anti-social personality disorder (ASPD). So this changed my question for this musing immediately; does Kevin McCallister fulfil the criteria for ASPD?

As Kevin McCallister is American it seemed right to base any diagnosis against the criteria of the American Psychiatric Association. Fortunately, they publish their diagnostic criteria in the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM) now in its 5th iteration published in 2013. The DSM defines the essential features of a personality disorder as “impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits.” The DSM 5 details very clear criteria to make a diagnosis of ASPD.

First there needs to be significant impairments in self functioning AND in interpersonal functioning.

DSM defines impairments in self functioning as either identity or self-direction:

a.Identity: Ego-centrism; self-esteem derived from personal gain, power, or pleasure.

b.Self-direction: Goal-setting based on personal gratification; absence of prosocial internal standards associated with failure to conform to lawful or culturally normative ethical behaviour.

Kevin certainly has high self-esteem. In Home Alone he genuinely believes that through his own power he has made his own family disappear. A belief that prompts celebration:

In terms of conforming to legal or ethical behaviour at no point in either film does he seek to tell the police or authorities that he’s home alone or at risk of the Wet Bandits. Indeed, he shop lifts albeit inadvertently in the first film and uses his father’s credit card to book into a luxury hotel in the second. He certainly uses his freedom for personal gratification spending $967 ($1,742.98 in today’s money) on room service alone in Home Alone 2.

So far it seems like he’s ticking the boxes without us even mentioning the vigilante justice. More of that violence later.

On to interpersonal functioning, defined by the DSM as either in empathy or intimacy:

a.Empathy: Lack of concern for feelings, needs, or suffering of others; lack of remorse after hurting or mistreating another.

b.Intimacy: Incapacity for mutually intimate relationships, as exploitation is a primary means of relating to others, including by deceit and coercion; use of dominance or intimidation to control others.

Speaking as a doctor in Emergency Medicine let’s get this straight: Kevin would have killed the Wet Bandits several times over. Especially in the second film where to start he throws four bricks on Marv’s head from height. Marv would be dead. No question. Kevin McCallister is attempting murder:

Later on, he sets up elaborate traps and stays around rather than running away (like most would do) merely to supervise Marv getting electrocuted and Harry setting fire to his head:

At no stage does he show any remorse and actually celebrates what he’s doing. Prior to meeting Kevin the Wet Bandits were cartoon villains, non-violent and stupid. Did they deserve to die? Kevin obviously felt it was worth risking it and enjoyed it.

He does form friendships in both films with people he previously feared; Old Man Marley and the Pigeon Lady. He inspires the former to re-connect with his family and gives the latter a present. This does suggest that he can form bonds with people. However, both were useful to him by helping him escape the Wet Bandits so it could be argued he was exploiting and rewarding them for his own benefit. This bit is open to debate but for the benefit of the blog lets assume this was Machiavellian manipulation and move on.

The patient then needs to have pathological personality traits in antagonism and disinhibition.

The DSM defines antagonism as:

a.Manipulativeness: Frequent use of subterfuge to influence or control others; use of seduction, charm, glibness, or ingratiation to achieve one„s ends.

b.Deceitfulness: Dishonesty and fraudulence; misrepresentation of self; embellishment or fabrication when relating events.

c. Callousness: Lack of concern for feelings or problems of others; lack of guilt or remorse about the negative or harmful effects of one’s actions on others; aggression; sadism.

d. Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults; mean, nasty, or vengeful behaviour.

We’ve already looked at Kevin’s violence and cruelty. He’s also certainly a master of deception. Throughout both films he is adept at speaking to adults and painting stories with great ease. Lying comes very easily to him as does using props and music whether to pretend to be his dad in the shower, a gangster with a gun or even a house full of celebrating people:

This is a crafty kid who is willing to lie and smile while doing it.

Disinhibition is defined by the DSM as:

a. Irresponsibility: Disregard for – and failure to honor – financial and other obligations or commitments; lack of respect for – and lack of follow through on – agreements and promises.

b. Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing and following plans.

c.Risk taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard for consequences; boredom proneness and thoughtless initiation of activities to counter boredom; lack of concern for one’s limitations and denial of the reality of personal danger

In both films Kevin shows poor regard for his own safety, whether climbing down a rope soaked in kerosine, zip-lining from the roof of his house or climbing his brother’s shelves:

Early on in both films he is shown impulsively lashing out in anger when he feels frustrated at having his pizza eaten or embarrassed in public during his choir solo. Kevin is not inhibited:

And violence is clearly natural to him. So far…seems to be meeting all the criteria.

Finally these factors must be consistent across time and place. They must not be due to intoxication or head injury.

As Kevin behaves the same in Home Alone (1990, set in Chicago) and Home Alone 2 (1992, set in New York) we can assume his behaviour is consistent to time and place. At no point is he seen taking drugs or drinking alcohol so we can rule those out as a cause. He does hit his head slipping on ice in Home Alone 2 but that’s very late on and isn’t shown to effect his behaviour in any way. Once again he’s meeting criteria.

They must not be better understood as “normative for the individual’s developmental stage or socio- cultural environment.”

Kevin is a remarkable child acting in a way we wouldn’t expect of a boy his age. He definitely has, at best, a chaotic family and there’s no doubt that after Home Alone 2 social services would have come down on the McCallister family like a tonne of bricks:

However, the house is pristine and all the children look well nourished and dressed. While there’s plenty of questions about what kind of job the McCallisters must do in order to fund this lifestyle there’s no indication that this is a family where violence is the norm. Box ticked again.

Finally, the individual is at least age 18 years.

Ah, here it falls down right at the last. Kevin is 8 in Home Alone and so well below the age where we can diagnose ASPD. NICE does have a Quality Standard (QS59) first published in 2014 aimed at identifying children at risk of ASPD. This includes interventions for the whole family. But in no way can a conclusive diagnosis be made in a child.

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So is Kevin McCallister a psychopath? By the DSM diagnostic criteria the answer is no. Does he show some traits that might set off alarm bells? The answer is yes. However, there is a debate about whether ‘psychopathy’ is an evolved trait which has been able to survive through natural selection as it has benefited human society to have individuals without morals prepared to do whatever it takes to achieve their goals (Glenn, Kurzban and Raine, 2011). Maybe we should celebrate Kevin’s innate traits as he uses them to defend himself and his family. After all, it means the bad guys get caught and it wouldn’t really make good films if he just rang the police like a good citizen.

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Time to be serious now. This blog does highlight a big issue I find with mental health. Almost ahead of any other profession people are all too willing to play ‘keyboard psychiatrist’ and diagnose public figures such as Donald Trump with a mental illness. Whilst this blog is meant as a bit of fun it shows how mental health has very clear diagnostic criteria to be met before we use loaded terms such as ‘psychopath’. That can be my Christmas message: before you make a stigmatising diagnosis make sure you know what you’re talking about. In fact in general: research first, speak later. Let’s be nice people.

Merry Christmas, you filthy animals

*Yes, I am aware there is a ‘Home Alone 3’ and even somethings called Home Alone 4: Taking Back the House and Home Alone: The Holiday Heist. I just choose to ignore them as we all should.

Home alone tooth.gif


Glenn, A., Kurzban, R. and Raine, A. (2011). Evolutionary theory and psychopathy. Aggression and Violent Behavior, 16(5), pp.371-380.

Hopwood, C. J., Thomas, K. M., Markon, K. E., Wright, A. G., & Krueger, R. F. (2012). DSM-5 personality traits and DSM-IV personality disorders. Journal of abnormal psychology121(2), 424-32.